Provider Demographics
NPI:1841700762
Name:TOMICH, MARK STEPHEN JR (PA-C)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:STEPHEN
Last Name:TOMICH
Suffix:JR
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:4217 NORTHERN PIKE
Mailing Address - Street 2:
Mailing Address - City:MONROEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15146-2713
Mailing Address - Country:US
Mailing Address - Phone:412-372-9100
Mailing Address - Fax:412-372-6952
Practice Address - Street 1:4217 NORTHERN PIKE
Practice Address - Street 2:
Practice Address - City:MONROEVILLE
Practice Address - State:PA
Practice Address - Zip Code:15146-2713
Practice Address - Country:US
Practice Address - Phone:412-372-9100
Practice Address - Fax:412-372-6952
Is Sole Proprietor?:No
Enumeration Date:2017-10-05
Last Update Date:2020-10-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMA059541363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant